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Katy McCarthy / JJIE

While researchers may offer differing numbers regarding just how many young people in the United States’ juvenile justice system have mental health or behavioral disorders, the consensus among experts is that most teens and adolescents in the system do.

A 2010 Columbia University study involving approximately 10,000 young people in the nation’s juvenile justice system found almost 52 percent of the population studied met criteria for at least one mental health disorder, with about 64 percent of young people who were committed to secured facilities likely having at least one disorder. A 2006 study published by the National Center for Mental Health and Juvenile Justice (NCMHJJ) involving more than 1,400 juveniles in three states made an even larger estimate, with approximately 70 percent of the young people studied meeting criteria for at least one mental or behavioral disorder.

Illustration by Katy McCarthy / JJIE

Read more from the series: Mental Health and the Juvenile Justice System: Progress, Problems and Paradoxes.

According to Dr. Joseph Cocozza, NCMHJJ researcher, the prevalence of mental disorders increases among juvenile offenders when leaping from short-term detention to longer-term, secured facility detainment. “The deeper the penetration into the system,” he said. “The higher the rate.”

“The bottom line is, there have been a number of major studies over the years, including the work we did as a result of funding from the Office of Juvenile Justice and Delinquency Prevention, and there has just been incredible consistency,” Cocozza said. “Between 60 and 70 percent of youth who come into contact with the juvenile justice system met the criteria for one or more mental health disorders.”

While experts differ on the extent to which mental health should be a focus in the juvenile justice system, there does appear to be agreement on several fronts. The fact that a large percentage of juveniles involved in the deep end of the system have mental health disorders is not debated; nor is it questioned that numerous deficits -- in terms of trained personnel and funding -- represent a clear barrier to addressing the needs of juveniles with mental health issues.

The Size of the Problem

“In many juvenile justice facilities, the number has certainly been in excess of 50 percent,” said Dr. James Clark, a private practitioner in Rochester, N.Y. He worked extensively with the population while at the Monroe County Children’s Center, a detention facility housing juvenile offenders under the age of 16 who have committed serious crimes. “I would get referrals from judges and attorneys in family court [to evaluate] kids,” he said. “And there wasn’t a child that I saw over the years that didn’t have significant mental health related issues.”

Dr. Thomas Grisso, director of psychology and director of the law-psychiatry program at the University of Massachusetts Medical School, is one of the nation’s foremost experts on the issue of juvenile justice and young people with mental health disorders. In 1995, he co-created the Massachusetts Youth Screening Instrument (MAYSI-2), the most widely implemented mental health screening tool in the nation’s juvenile justice system.

“Depending on what part of the juvenile justice system you’re in, between 55 and 70 percent of kids meet criteria for one or more disorders,” he estimates.

Grisso said that the statistics remain consistent across the United States. He cites findings from a 2006 national collection -- which examined more than 70,000 cases, across 19 states, in nearly 300 juvenile facilities -- that seem to indicate that the proportion of youth who are “above clinical levels” on mental health assessment scales fluctuates little from region to region.

“Given the research that my group here at UMass has done, we found very little difference as you move from one state to another, or one city to another,” he said. “There’s not a great deal of difference if you go from Chicago to Los Angeles.”

Over the last 12 years, Grisso said that the number of states using mental health screenings in detention centers has increased significantly while identification of mental health issues on the front end have similarly improved. Although he believes the national system has come a long way in identifying young people with mental health disorders, the pressing problem as of late, he has observed, regards what facilities do after their populations have been screened and assessed.

“Identification is less of a problem than doing something about it once they’re identified,” he said. “What we’re worried about now is what you do about it when you can identify it?”

For Clark, formerly the chief psychologist and director of Monroe County’s Mental Health Clinic for Socio-Legal Services in New York, it’s a problem he’s encountered firsthand.

Learning disabilities, he said, were common, with disorders frequently interfering with children’s schoolwork and sometimes leading them to substance abuse. He encountered many young people with anxiety and poor self-concepts, as well as “an awful lot of depressed kids” over the years. Many of them, he said, were prone to suicidal thoughts.

Clark said that one of the major barriers to improved mental health treatment in juvenile justice facilities is a profound lack of qualified personnel. “In most instances in my experiences, they simply lack sufficient professional staff to be able to provide meaningful evaluations,” he said. Even fewer facilities, he said, are equipped with enough personnel to provide ongoing treatments for young people.

“One of the problems is that juvenile justice settings don’t necessarily have a tremendous amount of mental health support, so an awful lot of people who have legitimate diagnoses don’t get recognized,” he said.

A lack of professionalism on the part of staff conducting interviews and screening youth at intake, he said, is an often-overlooked problem in the juvenile justice system that may result in disastrous consequences for young people in lock-up.

“Kids are like anybody else,” he continued. “They invest when they feel a connection with the interviewer and feel some sense of trust. If they feel like somebody doesn’t particularly care, it’s very easy for them to say ‘yeah, I’ve got no problems.’”

Exactly What Do We Want the Juvenile Justice System to Do?

Some experts, like Dr. Jeffrey A. Butts of CUNY’s John Jay College of Criminal Justice, believe that the links between juvenile justice and mental health are often “distorted,” however.

“When you look at the data, it’s hard to see the whole picture,” he said. “Because we only have spotty information about this whole issue.”

Oftentimes, he said, state legislators and community stakeholders envision the juvenile justice system as a narrow spectrum that only covers deep-end juvenile offenders.

“When I say ‘system,’ I don’t mean locked facilities, deep-end incarceration or detention centers,” he continued. “When people use the word ‘system’ to mean locked facilities, of course you see high prevalence rates of all kinds of mental health and substance abuse and disorders.”

Butts said rates of mental health disorders in juvenile offenders tend to increase at every incremental step of the system -- with kids that are processed likelier to display mental health issues than kids that are arrested and kids that are prosecuted likelier to display mental or substance abuse disorders than juveniles that are only kept in overnight detention.

“I had a judge once tell me that 85 percent of the kids in ‘the system’ had mental health disorders,” Butts said. “The problem is, that number goes up at every stage in the system.” And it’s not just relegated to mental health disorders, Butts added; the deeper a juvenile is in the system, the likelier he or she is to have health deficits, educational problems, trauma or substance abuse issues, he stated.

“We are selecting, sorting, sifting and holding on to more serious problems as they go through the process, while accounting for charge severity,” he said. “That’s exactly what we want the juvenile justice system to do … hold on to problems in order to meet your needs, and if there’s a chance that a kid can survive without being drawn into the system, let’s give him or her that chance.”

While Butts believes mental health investments in deep-end correctional facilities are worthwhile, he questions the need for similar resources for front-end services, such as county juvenile probation departments.

“If you see every kid through the prism of mental health, you’re going to spend all your money on a few kids and not have anything for the rest of them,” he said. “Then, you’re not only squandering resources, you’re being duped by all of the advocates who push mental health at us all the time.”

Butts believes there’s a wide range of non-pathological reasons, wholly unrelated to mental health disorders, that may explain why many children end up in the system. “They’re in there because they’re adolescents [and] they take chances,” he said. “They don’t feel happy at school anymore, so they’re looking for gratification somewhere else.”

One out of every five children in the nation has some kind of mental health issue, he said; mental health in the juvenile justice system cannot be ignored, he continued, but making it a primary focus of the system may prove too massive an undertaking.

“If you have 100 kids in your office at a probation department, odds are that 15 to 20 of them have mental health issues, but that’s just as true if you’re waiting at the dentist office,” he concluded. “So if we think the juvenile justice system is designed to serve mental health problems, that’s a pretty big mission.”

Funding and Politics

“Clearly, it’s difficult in these recent years [to] add things like screening and assessments to treatment for mental health disorders,” Grisso said. “[But] there is virtually no economic reason to not do mental health screenings.”

The way tests are administered, however, can sometimes lead to invalidated responses. “We devise all these tools for identifying kids, and the problem is, when you put them into practice at detention centers, sometimes, they don’t get used the way they’re supposed to.” He also believes that some facility staff and administrators may be averse to using such tools, because they may identify a larger population with disorders whose needs they simply cannot meet.

While Grisso does not have data that indicates a link between improved mental health treatment and decreased likelihoods of recidivism, he does find evidence that children screened at intake are likelier to obtain treatment.

“We found that when the MAYSI-2 was put in place,” he said, “it does increase staff members’ referrals to mental health services for kids who are in detention.”

Both Grisso and Clark believe that economics are an underlying issue regarding mental health treatment in the nation’s juvenile justice system.

Clark said that in his experiences, encountering a juvenile justice facility with full-time mental health staff was incredibly rare. “A few more have some kind of part-time consulting staff, but frequently, those consultants are misused,” he said. “In one facility, they had a physician who would come in for health screenings and the judges and courts were repeatedly asking that physicians for mental health evaluations, which was a bit outside their area of expertise.”

Many times, Grisso said that funding and budgeting shortfalls prevent facilities from providing treatment for young people after they are diagnosed with mental or behavioral disorders.

“Getting services and getting consultants, and referring kids,” he said. “There, the economics get very, very difficult.”

“States and communities that are more affluent sometimes do a better job, but even that’s not guaranteed,” Clark said. “States and communities that are short on bucks or facing other kinds of budgetary issues tend to not finance adult justice, and they very frequently ignore juvenile justice.”

He even believes that politics may prove a factor in why mental health treatment is so lacking in many of the nation’s juvenile justice facilities.

“Privatization of services was placing a tremendous burden on my clinic’s ability to provide care to people in jail,” he concluded. “And when I raised that with my county legislator, what he points out to me, in a very straightforward way is, ‘you know, Jim, the people in the jail and their families don’t vote.’”

Related Series

It presents one of the most vexing challenges facing our nation’s juvenile courts and corrections systems: how to treat, supervise, punish or just plain cope with troubled teens whose delinquent behaviors are connected to or caused by emotional disturbances and mental health problems. Many recent studies concur that two-thirds or more of all youth confined in juvenile facilities nationwide suffer from one or more mental conditions, and perhaps one in five suffers from a serious and debilitating mental illness – far more than in the general youth population. Awareness of the mental health/juvenile justice challenge is rising. Still, all across the country juvenile justice systems are struggling to respond.